Why Pain Assessment Matters
Pain is often underdetected and undertreated in care home residents, particularly those who cannot verbally express discomfort. Up to 80% of people with dementia experience pain, yet many cannot tell us. The Abbey Pain Scale provides a systematic way to identify and document pain through observable behaviours.
What is the Abbey Pain Scale?
The Abbey Pain Scale is a validated tool designed to assess pain in people who cannot verbally communicate. It measures pain through six behavioural categories, each scored 0-3, giving a total score of 0-18.
The Six Categories
Vocalisation
Sounds the person makes
Facial Expression
How the face looks
Change in Body Language
How the body moves or is held
Behavioural Change
Changes from usual behaviour
Physiological Change
Physical signs
Physical Changes
Observable physical indicators
Interpreting the Total Score
Continue monitoring. Reassess if concerns.
Consider comfort measures. Review in 1 hour. Consider PRN analgesia.
Action required. Administer prescribed analgesia. Inform nurse in charge. Review in 1 hour.
Urgent action. Administer strongest available analgesia. Contact GP urgently. Stay with resident.
How to Conduct the Assessment
- Observe at rest: Watch the person for 1-2 minutes without interaction
- Observe during movement: Assess during personal care or repositioning
- Score each category: Use 0-3 based on observed behaviours
- Calculate total: Add all six category scores
- Identify pain type: Note whether pain appears chronic, acute, or both
- Document and act: Record findings and take appropriate action
Important Considerations
- - Know the person's baseline behaviour to detect changes
- - Some behaviours may indicate distress other than pain
- - Assess before and after analgesia to evaluate effectiveness
- - Train all staff to use the scale consistently
When to Assess
- Routinely: As specified in care plan (e.g., daily, weekly)
- During personal care: When moving, washing, dressing
- When behaviour changes: New agitation, withdrawal, calling out
- After pain relief: 30-60 minutes after analgesia
- Post-procedure: After any intervention that may cause pain
Documentation Requirements
For each Abbey Pain Scale assessment, document:
- Date and time of assessment
- Staff member conducting assessment
- Score for each of the six categories
- Total score
- Context (at rest, during care, etc.)
- Action taken based on score
- Effectiveness of any intervention
Linking to Care Plans
The resident's pain management care plan should include:
- Known painful conditions
- Typical pain indicators for this individual
- Assessment frequency
- Prescribed analgesia and PRN protocols
- Non-pharmacological comfort measures
- Escalation pathway
Related Clinical Guides
Pain Assessment Made Easier
Revitaco includes built-in Abbey Pain Scale assessments with automatic scoring, trend tracking, and alerts when pain levels require action.
Book Your Demo